Cirrhosis influences quality of life after liver transplant

This month's issue of Clinical Transplantation investigates factors influencing change in health-related quality of life after liver transplantation.

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Dr Begoña Estraviz and colleagues from Spain assessed health-related quality of life in patients following liver transplantation, and the factors associated with health-related quality of life variation.

The team collected sociodemographic and clinical data for 60 consecutive patients activated for liver transplantation in a single hospital.

Patients were classified according to the severity of the cirrhosis, and disease etiology, such as alcoholic cirrhosis, viral cirrhosis, cholestatic diseases, and hepatocarcinoma.

6-months post-transplant, the scores on most domains remained below 50

Clinical Transplantation

Health-related quality of life was assessed by 3 different questionnaires.

The investigative team used the Health Survey Short Form 36, the Hospital Anxiety and Depression Scale, and a specific-symptom questionnaire.

Questionnaires were completed during the pre-operative period and 6 months after transplantation.

The team found in the pre-operative period, patients with Child A had higher mean levels of health-related quality of life than did those in other groups.

At 6 months following transplantation, there were no significant differences among the groups.

The investigators noted that this was largely because gains obtained by patients with Child B and C were much greater than those attained by patients with Child A.

The team found across the 4 etiological groups, there were significant differences in all domains of the 3 questionnaires.

The exceptions were bodily pain scored using the Health Survey Short Form-36, and anxiety as measured by the Hospital Anxiety and Depression Scale prior to transplantation.

The investigators noted that this was because patients with hepatocarcinoma had much better health-related quality of life.

The team found after transplantation, there were no differences because patients with viral and alcohol-induced cirrhosis achieved greater gains with respect to the neoplastic group.

During the pre-operative period, the scores for all areas of the Short Form-36 and for all groups were below the general population normalized score of 50.

The team reported that the only groups not below the general population normalized score were patients with Child class A, and those affected with hepatocarcinoma.

The investigators observed that 6-months post-transplantation, the scores on most of the domains remained below 50.

However, the team found that certain mental areas in which higher scores were attained in certain mental areas.

Dr Estraviz's team concluded, "Health-related quality of life is influenced by the severity and etiology of cirrhosis—patients with Child class C and those with alcoholic or viral cirrhosis have the poorest quality of life."

"There were no differences observed among the groups after the transplantation."

"The patients with the lowest health-related quality of life prior to surgery demonstrated greater gains in health-related quality of life associated with liver transplantation."